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Basic and Vital: A Struggle to Breathe

Fish out of water is an overused metaphor, but a good description of how I felt when I started working as a nurse. I’d been an English professor, accustomed to meditative talk with colleagues over coffee, to the security I got from books, to the knowledge that whatever my failings as a teacher, no one’s life was on the line.

Now I was alone in a hospital room with a young woman who couldn’t breathe.

A cancer patient who was battling a severe infection, she had been transferred to my floor from intensive care just half an hour earlier. She was sitting up in bed, gasping and shaking uncontrollably.

Her oxygen supply was connected and flowing, but the humidification system wasn’t bubbling the way it should. By this time she was moaning. “Turn it up!” she yelled. “Turn it up!”

I fiddled with the humidification, then decided not to wait. “I’m switching your oxygen,” I told her, yanking the tubing from the humidification system and reattaching it to the oxygen supply on the other side of her bed. Then I turned the oxygen up to six liters, the maximum you can deliver through the clear plastic cannulas that send oxygen into the nostrils.

But the sudden increase gave her no relief. She was still gaping, open-mouthed. I went back outside her room and grabbed a pulse-ox machine to check her heart rate and the saturation of oxygen in her blood.The “sats” measured just 80 percent (normal is 98 to 100), and the heart rate was even more alarming: 160, too quick to allow oxygen to circulate properly through her body, and so fast that her blood pressure might drop dangerously.

I stood at the foot of my patient’s bed like a sentinel, watching the pulse-ox: 69 for a second, then back to 80. Lisa came in, wheeling the crash cart, while another nurse carried the Zoll, our portable heart monitor and defibrillator.

Photo

Credit
Edel Rodriguez

A third nurse looked at the pulse-ox machine and then looked at me. “We should just call it,” she said, meaning that we should “call a condition,” bringing in a team from the I.C.U. to help.

Lisa made the call, and I guess I heard the announcement, “Condition C,” as in critical. Mostly what I remember is applying the defibrillator pads, and thinking that putting pads on a person who is shaking and gasping for air is very different from applying pads to a plastic dummy in a CPR class.

When the I.C.U. nurses and doctors arrived, we gave my patient some intravenous metroprolol to control her heart rate and put her on a “rebreather,” a mask that allowed us to deliver 15 liters of oxygen. Her sats climbed into the mid-90s, but her heart rate stayed high and she still felt she couldn’t breathe.

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In the end her symptoms, and the numbers, said it all, so she went back to intensive care, still gasping for air, her mouth open and tense under the mask. Breathing took so much effort that the muscles of her neck were drawn in deeply, like gills.

I found out later that the trouble lay in her carbon dioxide levels, which were far too high. Humans usually “blow off” CO2 as a normal part of respiration, but my patient couldn’t do that, probably because the cancer had blanketed her lungs.

Over the next two weeks she made more trips back and forth from intensive care. She would seem stable enough to return to the floor, and then she would suddenly need the kind of breathing support that only the I.C.U. could provide.

Then one day I learned she had died. Without an autopsy it’s impossible to say why, but the devastation to her lungs would have been more than enough.

“Fish out of water”: it works as a metaphor, but to see it in real life? I left academia for nursing because I wanted work that felt meaningful. I wrestled with the differences between university life and life in the hospital. I have struggled with my career change, but not one day, ever, have I struggled as hard as my patient did on that day just to breathe.

Theresa Brown is an oncology nurse and a regular contributor to the Well blog.

A version of this article appears in print on , on Page D5 of the National edition with the headline: Basic and Vital: A Struggle to Breathe. Order Reprints|Today's Paper|Subscribe